RESUMEN
OBJECTIVE: To review the incidence, management, and current understanding of the pathophysiology of ß-lactam-induced neutropenia and to critically evaluate the practicality and safety of direct substitution to an alternative ß-lactam in the setting of this reaction. DATA SOURCES: A literature analysis using the PubMed and Ovid search engines (July 1968 to October 2020) was performed using the search terms neutropenia, leukopenia, ß-lactam, nonchemotherapy, agranulocytosis, and G-CSF (granulocyte colony-stimulating factor). STUDY SELECTION AND DATA EXTRACTION: The included English-language studies evaluated the incidence, mechanism, and/or management of ß-lactam-induced neutropenia in pediatric or adult patients. DATA SYNTHESIS: Drug-induced neutropenia is a well-documented adverse reaction of ß-lactam antibiotics, with an incidence of approximately 10% following at least 2 weeks of intravenous therapy. However, multiple gaps in knowledge remain in the mechanism of pathophysiology and optimal management of this reaction. Both direct toxic and immune-mediated mechanisms have been implicated. Although the cornerstone of management includes cessation of the offending agent, controversy exists on the appropriateness of direct substitution or future use of an alternative ß-lactam. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Given the frequency of use and superiority of ß-lactams over alternative therapy for several infectious disease states, practical recommendations are needed on the management and safe use of ß-lactams following ß-lactam-induced neutropenia. CONCLUSION: Future use of ß-lactams with differing R1 side chains, particularly those from a separate class, should not be deemed contraindicated following ß-lactam-induced neutropenia and may be considered when indicated, with close laboratory monitoring.
